Q-What antiviral drug is recommended for pediatric patients with uncomplicated varicella/chickenpox?
The only antiviral drug available in a liquid formulation that is licensed for pediatric use is acyclovir.
Acyclovir therapy is not recommended routinely by the American Academy of Pediatrics for the treatment of uncomplicated varicella in the otherwise healthy child because of the marginal benefit, the cost of the drug, and the low risk for complications of varicella.
Q-When should treatment with acyclovir be initiated for uncomplicated varicella?
For better results , treatment should be initiated as early as possible, preferably within 24 hr of the onset of the exanthem. There is less clinical benefit if treatment is started more than 72 hr after the onset of the exanthem.
Q-In which individuals is acyclovir therapy recommended for the treatment of uncomplicated varicella?
Oral therapy with acyclovir (20 mg/kg/dose; maximum: 800 mg/dose) given as 4 doses/day for 5 days
It can be used to treat uncomplicated varicella in individuals at increased risk for moderate to severe varicella : nonpregnant individuals older than 12 yr of age and individuals older than 12 mo of age with chronic cutaneous or pulmonary disorders; individuals receiving short-term, intermittent, or aerosolized corticosteroid therapy; individuals receiving long-term salicylate therapy; and possibly secondary cases among household contacts. immediate treatment.
Q-What are the potential complications of varicella that may require intravenous acyclovir therapy?
Intravenous therapy is indicated for severe disease and for varicella in immunocompromised patients (even if begun more than 72 hr after onset of rash).
Any patient who has signs of disseminated VZV, including pneumonia, severe hepatitis, thrombocytopenia, or encephalitis,should receive
IV acyclovir therapy (500 mg/m²every 8 hr) initiated within 72 hr of development of initial symptoms decreases the progression of varicella and visceral dissemination in high-risk patients. Treatment is continued for 7-10 days or until no new lesions have appeared for 48 hr.
Delaying antiviral treatment in high-risk individuals until it is obvious that prolonged new lesion formation is occurring is not advisable because visceral dissemination occurs during the same period
Q-Which other drugs, besides acyclovir, may be used to treat varicella in older children who can swallow tablets?
Some experts recommend the use of famciclovir or valacyclovir in older children who can swallow tablets. These drugs are highly active against VZV by the same mechanism as acyclovir and are better absorbed by the oral route than acyclovir.
Valacyclovir (20 mg/kg/dose; maximum: 1,000 mg/dose, administered 3 times daily for 5 days) is licensed for treatment of varicella in children 2 to <18 yr of age, and both valacyclovir and famciclovir are approved for treatment of herpes zoster in adults.
HERPES ZOSTER
Q-What antiviral drugs are effective for the treatment of herpes zoster in healthy adults, and how long is treatment typically prescribed?
Antiviral drugs are effective for the treatment of herpes zoster. In healthy adults, acyclovir (800 mg 5 times a day PO for 5-7 days), famciclovir (500 mg tid PO for 7 days), and valacyclovir (1,000 mg tid PO for 7days) reduce the duration of the illness and the risk for development of postherpetic neuralgia.
Q-Is treatment of uncomplicated herpes zoster in otherwise healthy children always necessary with an antiviral agent, and why or why not?
In otherwise healthy children, herpes zoster is a less-severe disease, and postherpetic neuralgia usually does not occur. Therefore, treatment of uncomplicated herpes zoster in the child with an antiviral agent may not always be necessary, although some experts would treat with oral acyclovir (20 mg/kg/dose; maximum:800 mg/dose) to shorten the duration of the illness.
It is important to start antiviral therapy as soon as possible. Delay beyond 72 hr from the onset of rash limits its effectiveness.
Q-What is the recommended oral dose of acyclovir for the treatment of uncomplicated herpes zoster in children?
Treatment of uncomplicated herpes zoster in the child with an antiviral agent may not always be necessary, although some experts would treat with oral acyclovir (20 mg/kg/dose; maximum:800 mg/dose) to shorten the duration of the illness
Q-What is the importance of starting antiviral therapy for herpes zoster as soon as possible, and what is the time frame for effectiveness?
Start antiviral therapy as soon as possible. Delay beyond 72 hr from the onset of rash limits its effectiveness.
Q-What is the recommended treatment for immunocompromised children with herpes zoster, and why is it important for high-risk patients to receive this treatment?
Herpes zoster in immunocompromised children can be severe, and disseminated disease may be life-threatening. Patients at high risk for disseminated disease should receive IV acyclovir (500 mg/m² or 10 mg/kg every 8 hr).
Oral acyclovir, famciclovir, and valacyclovir are options for immunocompromised patients with uncomplicated herpes zoster, who are considered at low risk for visceral dissemination. Neuritis with herpes zoster should be managed with appropriate analgesics.
Use of corticosteroids in the treatment of herpes zoster in children is not recommended.
Best treatment of rheumatic fever-rule of 3